Independent risk factors of gestational diabetes mellitus

Independent risk factors of gestational diabetes mellitus | Image Credit: © zakalinka - © zakalinka - stock.adobe.com.

Independent risk factors of gestational diabetes mellitus (GDM) include being aged at least 30 years, having a body mass index (BMI) of 24.0 kg/m2 or greater, and having a history of adverse pregnancy outcomes or oral contraceptive use, according to a recent study published in the International Journal of General Medicine.¹

GDM is one of the most common complications of pregnancy, often leading to short- and long-term health risks for mothers and fetuses. These include eclampsia, gestational hypertension, macrosomia, diabetes, hyperinsulinemia, and shoulder dystocia. The risk of subsequent diabetes is also significantly increased in pregnant women with GDM and their offspring.

Extensive research has been conducted to evaluate the risk factors of GDM, but the results have been inconsistent across certain studies. Additionally, GDM risk factors may vary across different regions and populations.²

To identify high-risk populations for GDM and provide a scientific basis for reducing GDM, investigators conducted a cross-sectional study.¹ Participants included pregnant women visiting the obstetrics clinic of Meizhou People’s Hospital between 2019 and 2023 aged at least 18 and under 25 years.

Additional eligibility criteria included having a 75 g oral glucose tolerance test (OGTT) performed at 24 to 28 weeks’ gestation, a singleton pregnancy, and complete clinical data. Women without an OGTT test, with a disease that could impact metabolic function, with multiple pregnancy, or missing basic information were excluded.

GDM was determined based on fasting plasma glucose (FPG) of at least 5.1 mmol /L, 1-h plasma glucose of at least 10 mmol/L, or 2-h plasma glucose of at least 8.5 mmol/L during the OGTT. Additional data collected included age, early pregnancy BMI, and induced abortion, cesarean section, adverse pregnancy, and polycystic ovary syndrome (PCOS) histories.

The mode of conception during the current pregnancy and whether patients are to take contraceptives were also reported. Laboratory test indicators included blood cell analysis results, alpha-fetoprotein, human chorionic gonadotropin levels, and OGTT 1-hour and OGTT 2-hour blood glucose levels.

Of participants, 65.5% were aged under 30 years and 34.5% were aged at least 30 years. A history of PCOS was reported in 3.9%, induced abortion in 20.6%, cesarean section in 20.9%, adverse pregnancy in 17.5%, and oral contraceptive use in 6.3%. Natural conception was reported in 92.7% vs assisted reproductive technology in 7.3%.

Normal glucose tolerance (NGT) was reported in 82.5% of pregnant women and GDM in 17.5%. Rates of being aged at least 30 years and having a BMI of 24.0kg/m2 or higher were 30.4% and 23.1%, respectively, in the NGT group vs 53.7% and 43.3%, respectively, in the GDM group, implying higher rates among patients with GDM.

Patients with GDM also had higher rates of PCOS, cesarean section, adverse pregnancy, and oral contraceptive use, at 9%, 32.8%, 31.3%, and 14.9%, respectively, vs 2.8%, 18.4%, 14.6%, and 4.4%, respectively, in the NGT group. Assisted reproduction rates were 14.9% vs 5.7% in the GDM and NGT groups, respectively.

Significant associations with GDM were reported for age of at least 30 years, BMI of 24.0 kg/m2 or higher, history of PCOS, cesarean section, adverse pregnancy, oral contraceptive use, and assisted reproduction. The odds ratios for these factors were 2.661, 2.163, 3.355, 2.175, 2.680, 3.784, and 2.904, respectively.

These results indicated age of at least 30 years, BMI of 24.0 kg/m2 or higher, adverse pregnancy history, and oral contraceptive use as independent risk factors of GDM. Investigators recommended further research about the risk of GDM and elucidation of the underlying biological mechanisms.

References

1. Zhong J, Zhang H, Wu J, Zhang B, Lan L. Analysis of risk factors associated with gestational diabetes mellitus: A retrospective case-control study. Int J Gen Med. 2024;17:4229-4238. doi:10.2147/IJGM.S473972
2. Liu B, Lamerato LE, Misra DP. A retrospective analysis of the relationship between race/ethnicity, age at delivery and the risk of gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2020;33(17):2961–2969. doi:10.1080/14767058.2019.1566310